Lothian Surgical Audit

The Lothian Surgical Audit (LSA) was inaugurated in Edinburgh as a mortality audit by Professor Sir James Learmonth (1895-1967) in 1946. Taking the form of a confidential peer review, regular meetings were held on Saturday mornings for Edinburgh surgeons to meet and discuss the reasons for patient deaths.

Learmonth took his inspiration for these meetings from the mortality conferences held at the Mayo Clinic in Rochester, Minnesota where he was researching under a Rockefeller Fellowship in the late 1920s. During these conference meetings, surgical deaths were scrutinised behind closed doors, and while open accountability was undoubtedly uncomfortable for many taking part, such rigorous enquiry encouraged and supported the surgical excellence underpinning the Mayo. Learmonth returned to Scotland in 1932, and by 1942 held both surgical Chairs in Edinburgh. At the close of the Second World War, Learmonth was concerned with demobilised soldiers returning to Edinburgh, who, despite having gained significant practice in battlefield injuries, had little experience in civilian surgery, and importantly, academic discipline and standards. It was against this backdrop that he looked back to the Mayo conferences, and initiated similar, closed-session meetings in his Edinburgh University Department of Clinical Surgery based in wards 7/8 of the Royal Infirmary.

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